Ebola Cases Pile Up

The West Africa outbreak continues to grow, according to the World Health Organization, with an additional 108 cases over the weekend.

by Michael Smith Michael Smith North American Correspondent, MedPage Today
August 06, 2014

The West Africa outbreak continues to grow, according to the World Health Organization (WHO), with an additional 108 cases over the weekend.

But one case outside the region has been ruled out — a man admitted to New York City's Mount Sinai Hospital Monday does not have the disease. hospital officials said Wednesday evening.

"The patient is in stable condition, is improving, and remains in the care of our physicians and nurses," the hospital said in a statement. It gave no further information.

The new patients in West Africa bring the total confirmed, suspected, and probable cases in the four affected countries to 1,711, with 932 deaths, the agency reported. The outbreak is thought to have begun in late 2013 in Guinea's Guéckédou prefecture, just over 8 months ago.

For comparison, the cumulative number of cases in all previous outbreaks of Zaire ebolavirus -- the species responsible for the current outbreak -- is 1,381 over some 40 years, with 1,083 deaths.

Before the current outbreak, the cumulative total of cases for all five species of ebolavirus was just over 2,400, with 1,507 deaths.

The WHO's new figures come as the agency began deliberations in Geneva over whether to classify the outbreak as a public health emergency of international concern under the International Health Regulations.

One of the key factors in the decision is the risk of the disease spreading internationally. Until recently, the disease has been confined to Guinea and its neighbors Liberia and Sierra Leone.

But Nigeria, about 600 miles east of the three countries, is now reporting nine confirmed, suspected, or probable cases, with one death, after a man working in Liberia flew to Lagos and died there.

The WHO said Nigeria is now tracing contacts of the index case, Patrick Sawyer, and setting up a treatment center to manage potential Ebola patients. NBC News is reporting that a nurse who treated Sawyer has also died, quoting the Nigerian health minister, but the WHO did not confirm the report.

Other reports suggest possible but limited international spread.

Saudi Arabian health officials are being quoted as saying that a 40-year-old man returning from a business trip to Sierra Leone is being tested for Ebola after he showed up at a Jeddah hospital with symptoms of a viral hemorrhagic fever.

WHO Director-General Margaret Chan, MD, said in a statement that the agency's response to the outbreak will include "taking steps" to reduce the risk of international spread, although she did not elaborate.

One possible step -- screening air passengers before they leave -- is currently being tested in Guinea, the WHO said.

The WHO and the affected countries will also begin treating Guéckédou, Kenema, and Foya -- areas that are contiguous but lie in Guinea, Sierra Leone, and Liberia, respectively -- as a unified region for public health purposes.

The three countries will introduce measures "meant to reduce movement in and out of the area," the agency said.

In Guinea, new Ebola hotspots continue to flare up, which will need new case management facilities, the WHO said.

Those battling the outbreak continue to face what the WHO called "security issues" in Liberia, where health workers have been blocked from affected regions and in some cases attacked. "Community resistance remains high," the agency said.

In the wake of reports that two Americans stricken with Ebola were given an investigational antibody cocktail, the WHO is also convening an expert panel to "explore the use of experimental treatment" in the outbreak.

Kent Brantly, MD, and hygienist Nancy Writebol were given the medication, which had not previously been given to humans, while they were in Liberia, awaiting air transfer to Emory University Hospital in Atlanta.

In animals, the cocktail completely protects nonhuman primates when given within 24 hours of infection, MedPage Today was told, but in the absence of human trials it might never be clear what effect -- if any -- it had on the disease course in the two Americans.

Their treatment raises questions about whether untested medicines should be used in the outbreak and, if they are, who should get the limited quantities that are available, the WHO said.

"We are in an unusual situation in this outbreak. We have a disease with a high fatality rate without any proven treatment or vaccine," according to Marie-Paule Kieny, PhD, the agency's assistant director-general.

"We need to ask the medical ethicists to give us guidance on what the responsible thing to do is," she said in a statement.

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